1
CHAPTER 15
Transplantation of Tissues and Organs
Questions
15–1
When an individual receives a kidney transplant, the main concern will be to control the
development of _____.
a. graft-versus-host disease
b. transplant rejection
c. xenorecognition
d. allergic reactions
e. lymphoproliferative disorders.
15–2
In the context of organ transplantation, what is the increased risk associated with an individual’s
having received previous blood transfusions on multiple occasions?
15–3
Which of the following are correctly matched? (Select all that apply.)
a. allograft: same person
b. autograft: to treat damage caused by autoimmune processes
c. isograft: syngeneic
d. antithymocyte globulin: xenogeneic
e. same species: allogeneic.
15–4
Alloantibodies specific for HLA class I molecules can mediate hyperacute rejection of kidney
transplants. Explain under what conditions an individual would possess preexisting antibodies
against HLA class I polymorphisms.
15–5
Blood transfusions mismatched for ABO and/or rhesus antigens are associated with _____.
(Select all that apply.)
a. type III hypersensitivity reactions
b. alloreactive immune responses
c. lysis of recipient red blood cells
d. laboratory errors in the cross-matching procedure
e. activation of host complement and destruction of donor cells.
15–6
Alloantibodies to blood-vessel endothelium on solid organ grafts _____.
2
a. are specific for HLA class I and class II antigens
b. cause hyperacute rejection
c. cause acute rejection
d. target endothelium for attack by NK cells
e. are IgA and do not fix complement.
15–7
Which of the following is a permissible match between a blood donor and a recipient (donor:
recipient)? (Select all that apply.)
a. O –: AB +
b. O +: AB –
c. AB +: O –
d. A –: A +
e. AB –: O +.
15–8
In general the higher the patient’s panel reactive antibody (PRA), _____.
a. the higher the number of suitable transplant donors
b. the less likely it is that a hyperacute reaction will occur
c. the higher the risk of developing hemolytic disease of the newborn
d. the more limited the number of suitable transplant donors
e. the higher the risk of developing autoimmunity.
15–9
If _____ occurs in an organ to be transplanted, endothelial activation, leukocyte infiltration,
inflammatory cytokine production, and complement activation may occur.
a. a mixed lymphocyte reaction
b. the transfusion effect
c. kidney dialysis
d. ischemia
e. myeloablative therapy.
15–10
Which of the following are correctly matched? (Select all that apply.)
a. hyperacute rejection: preexisting antibodies against cell-surface antigens
b. acute rejection: anti-HLA antibodies
c. chronic rejection: alloreactive T-cell clones specific for HLA allotypes of donor
d. acute rejection: direct pathway of allorecognition
e. transfusion effect: indirect pathway of allorecognition.
15–11
Acute rejection of a kidney graft involves the activation of recipient T cells by _____ of _____
origin.
a. dendritic cells; recipient
b. B cells; recipient
c. dendritic cells; donor
3
d. macrophages; recipient
e. B cells; donor.
15–12
Effector mechanisms of _____ rejection resemble those responsible for type IV hypersensitivity
reactions.
a. xenogeneic
b. acute
c. chronic
d. hyperacute
e. blood transfusion.
15–13
When donor MHC:donor self-peptide complexes activate recipient T cells, _____.
a. acute rejection of transplanted organs occurs
b. suppression occurs and transplanted organs are tolerated
c. hyperacute rejection of transplanted organs occurs
d. complement pathways are activated
e. an indirect pathway of allorecognition occurs.
15–14
The extent to which an individual’s T cells respond to allogeneic HLA expressed on irradiated
donor cells can be measured in vitro using _____.
a. a cross-match test
b. a superantigen recognition test
c. the mixed lymphocyte reaction
d. the transfusion effect assay
e. the panel reactive antibody test.
15–15
In a mixed lymphocyte reaction the donor cells are irradiated to ensure that they do not _____.
a. stimulate recipient cells
b. become anergic
c. alter their level of expression of HLA molecules
d. proliferate
e. undergo apoptosis.
15–16
What explains the increased incidence of bone marrow graft failure and cancer relapse when
mature T cells are depleted from donor bone marrow before engraftment?
15–17
As the number of expressed MHC isoforms in the thymus increases beyond a certain value, the
T-cell repertoire _____.
a. becomes smaller
b. becomes more diverse
4
c. is unaffected.
15–18
In chronic rejection, effector T cells respond to _____ complexes on _____-derived dendritic
cells.
a. donor MHC class I:donor self peptide; donor
b. donor MHC class II:donor self peptide; donor
c. recipient MHC class I:donor MHC peptide; recipient
d. recipient MHC class II:donor MHC peptide; recipient
e. recipient MHC class II:donor MHC peptide; donor.
15–19
Alloantibody production after organ transplantation involves _____.
a. a mixed lymphocyte reaction
b. the indirect pathway of allorecognition by CD4 T cells
c. activation of regulatory CD4 T cells
d. the transfusion effect
e. a switch from a chronic to an acute state of organ rejection.
15–20
As time progresses following an organ transplant, the alloreactive T-cell response shifts from
a(n) _____ pathway to a(n) _____ pathway of allorecognition.
a. exogenous; endogenous
b. inflammatory; cytotoxic
c. hyperacute; suppressive
d. autologous; heterologous
e. direct; indirect.
15–21
Patients who have previously received a blood transfusion that has HLA-DR allotypes in
common with their kidney transplant are _____.
a. less likely to reject the graft owing to the presence of regulatory CD4 T cells
b. more likely to reject the graft owing to the presence of HLA alloantibodies
c. less likely to reject the graft owing to negative selection of alloreactive T-cell clones
d. at risk of developing a hyperacute rejection
e. at risk of developing graft-versus-host disease.
15–22
The outcome of organ transplantation improves when _____. (Select all that apply.)
a. the patient has been transfused with blood sharing HLA allotypes with the transplanted
organ
b. HLA-A, HLA-B and HLA-DR are matched
c. a thymectomy is performed at the time of transplantation
d. plasmapheresis is carried out before transplantation
e. immunosuppressive drugs are used to prevent the activation and proliferation of T cells.
5
15–23
Which of the following are correctly matched? (Select all that apply.)
a. prednisone: pro-drug
b. rapamycin: calcineurin
c. azathioprine: cytotoxicity
d. methotrexate: NFB
e. cyclophosphamide: microbial products.
15–24
_____ is a nitrogen mustard compound converted to a DNA-alkylating agent in the body that is
used to inhibit cell proliferation after transplantation.
a. Methotrexate
b. Rapamycin
c. FK506
d. Cyclophosphamide
e. Mycophenalate mofetil.
15–25
Prednisone is a steroid used in transplantation that _____. (Select all that apply.)
a. binds to a cell-surface receptor and inhibits the function of NFB
b. is combined with cytotoxic drugs to improve its efficacy
c. decreases the synthesis of IB
d. causes a decrease in production of inflammatory cytokines
e. can lead to bone demineralization as an unwanted side-effect.
15–26
Which of the following immunosuppressive drugs functions by inhibiting DNA synthesis?
(Select all that apply.)
a. cyclophosphamide
b. prednisone
c. azathioprine
d. methotrexate
e. mycophenalate mofetil
f. cyclosporin A
g. tacrolimus.
15–27
_____ decreases the activity of the transcription factor NFAT by inhibiting calcineurin. (Select
all that apply.)
a. Tacrolimus
b. Azathioprine
c. Mycophenolic acid
d. Cyclosporin A
e. Rapamycin.
15–28
6
Indicate whether each of the following statements is true (T) or false (F).
___ a. Dosage of immunosuppressive drugs is often decreased in transplant patients to minimize
toxic side-effects, but there is a risk of rejection.
___ b. Antithymocyte globulin (ATG) is a monoclonal antibody specific for T-cell surface
antigens.
___ c. Immunosuppressive xenogeneic antibodies can be used repeatedly for multiple episodes
of transplant rejection without complication.
___ d. Daclizumab, an anti-CD3 humanized antibody, is used to treat and prevent acute
rejection.
___ e. A possible side-effect of using antilymphocyte globulin (ALG) is serum sickness.
15–29
Steroid receptors are complexed with _____.
a. Hsp90 in the cytoplasm
b. Hsp90 on the cell surface
c. calcineurin in the cytoplasm
d. calcineurin in the nucleus
e. NFB in the cytoplasm.
15–30
Corticosteroids interfere with chemotaxis of leukocytes by _____.
a. decreasing the production of GM-CSF and IL-1
b. inducing apoptosis
c. inhibiting the expression of adhesion molecules on endothelial vessels
d. suppressing the activity of phospholipase A2
e. reducing nitrogen oxide synthase (NOS) activity.
15–31
Tacrolimus causes which of the following effects? (Select all that apply.)
a. reduced T-cell proliferation
b. decreased production of nitric oxide
c. decreased production of IL-3, IL-4, GM-CSF, and TNF-
d. decreased activity of cyclo-oxygenase type 2
e. serum sickness.
15–32
Which of the following is an effect of both tacrolimus and corticosteroids?
a. reduced T-cell proliferation
b. decreased production of nitric oxide
c. decreased production of IL-3, IL-4, GM-CSF, and TNF-
d. decreased activity of cyclo-oxygenase type 2
e. serum sickness.
15–33
Barriers to using pig organs in human transplantation are _____. (Select all that apply.)
a. the transfer of endogenous pig retroviruses to humans
7
b. that pig organs secrete high levels of cytokines that induce inflammation in humans
c. that humans contain preexisting alloantibodies that bind to pig carbohydrate antigens on
pig endothelium
d. that pig MHC molecules stimulate strong xenoreactive T-cell responses
e. that pig complement regulatory proteins do not inhibit human complement.
15–34
Which of the following human molecules would be candidates for genetic modification of pigs to
make these animals more suitable as organ donors for humans? (Select all that apply.)
a. membrane co-factor protein (MCP)
b. decay-accelerating factor (DAF)
c. HLA class II
d. HLA class I
e. CD59.
15–35
A characteristic of the human eye that enables the cornea to be transplanted with a 90% success
rate is that _____. (Select all that apply.)
a. antigen-presenting cells in the eye do not express the co-stimulatory molecule B7
b. the cornea is not vascularized
c. anterior-chamber-associated immune deviation (ACAID) establishes a state of tolerance
in the eye
d. only regulatory T cells express the adhesion molecules necessary to enter the cornea
e. the aqueous humor of the anterior chamber contains TGF-, which downregulates CD40
and inhibits IL-12 secretion.
15–36
Which of the following are transplanted with a relatively high success rate despite major
differences in HLA class I and II between donor and recipient? (Select all that apply.)
a. bone marrow
b. heart
c. cornea
d. kidney
e. liver.
15–37
Liver transplantation requires that _____ be matched between donor and recipient. (Select all
that apply.)
a. HLA class I
b. HLA class II
c. ABO antigens
d. rhesus antigen.
15–38
_____ is/are a disease or genetic defect that can be treated by bone marrow transplantation.
(Select all that apply.)
8
a. A leukocyte defect
b. Multiple myeloma
c. Hemoglobin defects
d. Celiac disease
e. Acquired immune deficiency syndrome (AIDS).
15–39
Myeloablative therapy is carried out in bone marrow transplantation in order to _____. (Select all
that apply.)
a. prevent graft-versus-host disease
b. prevent host-versus-graft disease
c. suppress autoreactive T cells in the graft
d. disable the patient’s hematopoietic stem cells but not their circulating leukocytes
e. provide space for colonization of transplanted stem cells in bone marrow stroma
f. destroy tumors of immune-system cells.
15–40
For the patient’s new immune system to function effectively in bone marrow recipients, some
HLA allotypes must be shared because _____. (Select all that apply.)
a. professional antigen-presenting cells are host-derived
b. professional antigen-presenting cells are donor-derived
c. otherwise an autoimmune disease would develop
d. newly generated T cells are positively selected on the recipient’s thymic epithelium
e. if all HLA molecules were mismatched, acute rejection of the grafted cells would occur.
15–41
The risk of _____ is the primary complication in bone marrow transplants.
a. acute host-versus-graft disease
b. hyperacute rejection
c. chronic rejection
d. acute graft-versus-host disease
e. cancer.
15–42
_____ from a bone marrow transplant facilitate alloreactive responses, causing the condition
defined as acute graft-versus-host disease.
a. Natural killer cells
b. Mature T cells
c. Dendritic cells
d. Thymocytes
e. Mature B cells.
15–43
A patient diagnosed with grade IV of graft-versus-host disease would most probably exhibit
_____. (Select all that apply.)
a. serum bilirubin levels of 2-3mg/dl
9
b. jaundice
c. skin blistering and desquamation
d. severe abdominal pain
e. maculopapular rash on less than 25% of body surface.
15–44
Autologous bone marrow transplantation used to treat cancer patients involves reinfusing a(n)
_____-depleted stem-cell population into the patient after their cancer treatment has been
completed.
a. mature T cell
b. antibody
c. tumor cell
d. dendritic cell
e. NK cell.
15–45
Leukapheresis is used in hematopoietic stem-cell transplantation where stem cells from a suitable
donor are fractionated on the basis of their expression of _____.
a. CD3
b. the same major histocompatibility antigens as the recipient
c. the same minor histocompatibility antigens as the recipient
d. the same inhibitory KIR receptors as the recipient
e. CD34.
15–46
Donors treated with _____ can donate bone marrow-derived stem cells from a less invasive
peripheral blood draw instead of the more invasive bone marrow aspiration. (Select all that
apply.)
a. anti-CD3
b. cyclophosphamide
c. anti-CD34
d. granulocyte colony-stimulating factor (G-CSF)
e. granulocyte–macrophage colony-stimulating factor (GM-CSF).
15–47
Despite a slower engraftment, cord blood as a source of transplanted hematopoietic stem cells is
better than bone marrow or than stem cells derived from peripheral blood in that _____. (Select
all that apply.)
a. the recipient does not need to undergo myeloablative therapy
b. there is a higher degree of tolerance for HLA disparity
c. there is a lower incidence of graft-versus-host disease
d. cord blood can be infused directly into the bone marrow of recipients
e. a larger number of stem cells express CD34.
15–48
10
Males engrafted with HLA-identical bone marrow from their sisters develop graft-versus-host
disease because _____.
a. T cells develop in the male thymus that are not tolerant to minor histocompatibility
antigens expressed by the sister
b. mature T cells in the graft have specificity for male-specific minor histocompatibility
antigens
c. there are differences between the sexes in how self proteins are modified post–
translationally
d. NK-cell alloreactions occur
e. residual female hormones in the graft cause upregulation of HLA class I on male
dendritic cells presenting minor histocompatibility antigens.
15–49
Residual leukemia cells persisting in a patient after they have received chemotherapy, irradiation,
and a bone-marrow transplant are sometimes eliminated by a _____ effect which involves the
action of _____. (Select all that apply.)
a. graft-versus-leukemia; alloreactive T cells
b. haploidentical; regulatory T cells
c. acute minor histocompatibility; recipient NK cells
d. myeloablation; mature T cells
e. graft-versus-leukemia; alloreactive NK cells.
15–50
Family members who donate their bone marrow to a transplant patient and who share one out of
the two HLA haplotypes are providing a(n) _____ transplant.
a. autologous
b. HLA-matched
c. haploidentical
d. chimeric
e. cross-matched.
15–51
What is the term used to describe the condition of an individual who possesses two sets of
hematopoietic cells, one derived from the individual’s own bone marrow and one derived from a
different source, for example, an organ transplant or blood transfusion that has not been rejected?
a. haploidentical
b. chimeric
c. cross-protected
d. dimorphic
e. mixed lymphocyte reaction.
15–52
What is the probability that a sibling will be able to provide a HLA-haploidentical kidney for
transplantation?
a. 100%
b. 75%
11
c. 50%
d. 25%
e. 0%.
15–53
What explains the observation that mixed lymphocyte reactions carried out between some
dizygotic twins have a negligible stimulation index?
12
Answers
13
14